Yeungnam Univ J Med.  2019 May;36(2):155-158. 10.12701/yujm.2019.00115.

Imatinib-induced hepatitis treated by corticosteroids in a patient with metastatic gastrointestinal stromal tumor

  • 1Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
  • 2Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea.


Imatinib mesylate is currently used as the first-line treatment for metastatic gastrointestinal stromal tumors (GISTs). Imatinib-induced hepatotoxicity in patients with GIST is very rare. Its features vary from subclinical elevation of serum aminotransferase to clinically apparent acute hepatitis, which is associated with immunologic reactions. Imatinib-induced hepatotoxicity with autoimmune-like features can be treated by the discontinuation of imatinib mesylate and the administration of oral steroids. Here, we report a case of late-onset imatinib-induced hepatitis with autoimmune-like features in a patient with metastatic GIST, which was improved by oral corticosteroids.


Corticosteroids; Drug-induced liver injury; Gastrointestinal stromal tumors; Imatinib mesylate

MeSH Terms

Adrenal Cortex Hormones*
Drug-Induced Liver Injury
Gastrointestinal Stromal Tumors*
Imatinib Mesylate
Adrenal Cortex Hormones
Imatinib Mesylate


  • Fig. 1. Abdominal computed tomography reveals no evidence of recurrence of GIST from upper abdomen (A) to lower abdomen (B) after segmental resection of small bowel and peritonectomy for metastatic GIST. GIST, gastrointestinal stromal tumor.

  • Fig. 2. Histological findings of the liver. (A) There is interface hepatitis with inflammatory cells infiltrations of lymphocytes and plasma cells (arrows) in portal and periportal area (hematoxylin and eosin stain, ×100). (B) The centrilobular necrosis is present, with golden-brown colored ceroid pigment-laden Kupffer cells (arrows) and shrunken, eosinophilic apoptotic hepatocytes (arrow head) (hematoxylin and eosin stain, ×200).

  • Fig. 3. Clinical course of the patient. ALT, alanine aminotransferase.



1. Pariente A, Etcharry F, Cales V, Laborde Y, Ferrari S, Biour M. Imatinib mesylate-induced acute hepatitis in a patient treated for gastrointestinal stromal tumour. Eur J Gastroenterol Hepatol. 2006; 18:785–7.
2. Tonyali O, Coskun U, Yildiz R, Karakan T, Demirci U, Akyurek N, et al. Imatinib mesylate-induced acute liver failure in a patient with gastrointestinal stromal tumors. Med Oncol. 2010; 27:768–73.
3. Seidel C, Fenner M, Länger F, Bantel H, Ganser A, Grünwald V. Imatinib-induced liver cirrhosis in a patient with advanced gastrointestinal stroma tumor (GIST). BMC Cancer. 2012; 12:186.
4. Yachoui R. Early onset imatinib mesylate-induced hepatotoxicity in a patient with gastrointestinal stromal tumors. Am J Ther. 2014; 21:e148–50.
5. Ferrero D, Pogliani EM, Rege-Cambrin G, Fava C, Mattioli G, Dellacasa C, et al. Corticosteroids can reverse severe imatinib-induced hepatotoxicity. Haematologica. 2006; 91(6 Suppl):ECR27.
6. Al Sobhi E, Zahrani Z, Zevallos E, Zuraiki A. Imatinib-induced immune hepatitis: case report and literature review. Hematology. 2007; 12:49–53.
7. Guilhot F. Indications for imatinib mesylate therapy and clinical management. Oncologist. 2004; 9:271–81.
8. Sharma A, Houshyar R, Bhosale P, Choi JI, Gulati R, Lall C. Chemotherapy induced liver abnormalities: an imaging perspective. Clin Mol Hepatol. 2014; 20:317–26.
9. Joensuu H, Trent JC, Reichardt P. Practical management of tyrosine kinase inhibitor-associated side effects in GIST. Cancer Treat Rev. 2011; 37:75–88.
10. Almazroo OA, Miah MK, Venkataramanan R. Drug Metabolism in the Liver. Clin Liver Dis. 2017; 21:1–20.
11. Döring B, Petzinger E. Phase 0 and phase III transport in various organs: combined concept of phases in xenobiotic transport and metabolism. Drug Metab Rev. 2014; 46:261–82.
12. Willson TM, Kliewer SA. PXR, CAR and drug metabolism. Nat Rev Drug Discov. 2002; 1:259–66.
13. Hunt CM, Papay JI, Stanulovic V, Regev A. Drug rechallenge following drug-induced liver injury. Hepatology. 2017; 66:646–54.
14. Saif MW, Smith MH, Maloney A, Diasio RB. Imatinib-induced hyperbilirubinemia with UGT1A1 (*28) promoter polymorphism: first case series in patients with gastrointestinal stromal tumor. Ann Gastroenterol. 2016; 29:551–6.
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